Healthcare Provider Details

I. General information

NPI: 1073990867
Provider Name (Legal Business Name): EAR, NOSE, THROAT, SINUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 CALUMET AVE STE 101
MUNSTER IN
46321-2546
US

IV. Provider business mailing address

8840 CALUMET AVENUE SUITE 101
MUNSTER IN
46321-2546
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-2000
  • Fax: 219-836-8272
Mailing address:
  • Phone: 219-836-2000
  • Fax: 219-836-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JATIN RAMESH PATEL
Title or Position: PRESIDENT
Credential: DO
Phone: 219-836-2000